Financial Assistance Programs Research Articles

Bridging the financial assistance gap: A pilot study of a patient-facing app to identify drug financial assistance programs.

e18296 Background: Many cancer patients face high treatment-related costs and are often unaware of available financial resources. We designed “Bridge” as a stand-alone, smartphone app to reduce out-of-pocket treatment costs by connecting patients to tailored financial assistance programs. The goal of this pilot study was to evaluate the usability and preliminary effectiveness of Bridge. Methods: Eligible cancer patients were receiving anti-cancer treatment, owned a smartphone, and reported out-of-pocket treatment-related costs. Patients interacted with Bridge, inputted personal and financial data, and reviewed personalized financial resource results. Usability was assessed via the validated System Usability Scale (SUS). To be usable, patients would have to score at least 68 on the SUS. Effectiveness was assessed by two measures: “Bridge improved my knowledge about financial aspects of cancer care and what can be done about it” (1 = strongly disagree to 5 = strongly agree) and “Using this tool was helpful with my financial concerns” (1 = strongly disagree to 5 = strongly agree). Results: We enrolled 30 patients. 63% were female, 23% were non-white, 66% had greater than high school education, 97% were insured (48% Medicare), and 23% were employed. Median annual household income was $60,796. All patients completed a full interaction with the app, with median time to results of 116 seconds. 72% of patients matched to at least one currently open program, with patients matching to a median of 4 financial assistance programs. 90% of patients reported an SUS score of usable (i.e., > 68 out of 100). The median SUS score was 85. 83% of patients agreed or strongly agreed that “Bridge improved my knowledge about financial aspects of cancer care and what can be done about it.” 53% of patients agreed or strongly agreed that “Using this website was helpful with my financial concerns.” Conclusions: We found that patients rated Bridge as usable and acceptable. We also found that Bridge helped match most patients to relevant assistance programs and improved knowledge about financial aspects of cancer care. The next phase of this NCI-funded study will test the effectiveness of Bridge in a large, randomized, controlled trial.

Outcomes among minority patients with stage IV colorectal cancer in the Harris County Health System.

e18039 Background: Colorectal cancer (CRC) mortality has declined over the last three decades, but significant racial disparities in CRC survival continue to be reported, especially for stage IV disease. Hypothesizing that these disparities arise from differences in access to care rather than tumor biology, we examined treatment patterns and outcomes among minority patients evaluated and treated for stage IV CRC in an academic safety net health system. Methods: The Harris Health System is an integrated health delivery network that utilizes tax revenue to care for predominantly minority and uninsured residents of Harris County, Texas. As the largest Harris Health facility and an affiliate of the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine, Ben Taub Hospital delivers cancer care through multidisciplinary subspecialty clinics and a robust patient assistance program. We performed a retrospective analysis of minority patients diagnosed with stage IV CRC between 1/2010 and 12/2012 who were evaluated and treated at Ben Taub Hospital. Results: We identified 103 patients of whom 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. 65% spoke English as their preferred language; 74% were uninsured and covered by the Harris Health Plan, a financial assistance program for individuals with incomes under 300% of the federal poverty level. 85% of patients received cancer-directed therapy, of whom 99% received standard chemotherapy with a best response rate of 67% and a disease control rate of 87%. Median overall survival was 20.7 months for all patients and 23.0 months for patients who received chemotherapy. Conclusions: The Harris Health System provides the health delivery infrastructure through which minority patients with significant socioeconomic challenges obtain financial assistance and access to quality cancer care in an academic setting, thereby leading to clinical outcomes comparable to those of the predominantly Caucasian and insured populations studied in randomized control trials. Efforts to resolve disparities in CRC outcomes should focus on improving access of at-risk populations to comprehensive cancer care.

After the Visit: An Overview of Government and Community Programs Supporting Children with Medical Complexity.

The optimal care of children with medical complexity (CMC) requires involvement from a network of professionals that includes physicians, nurses, ancillary service providers, and educators. Pediatric health care providers typically have early and frequent contact with the families of CMC. Therefore, they are in a unique position to connect families to developmental, educational, and psychosocial supports. This article reviews important government and community programs that support CMC living in the United States. It outlines the educational rights of children with disabilities and offers practical tips for collaborating with Early Intervention and the public school system. The article also provides an overview of financial assistance programs, respite care services, and support groups that are beneficial to CMC and their families.

Patient Financial Assistance Programs: A Path to Affordability or a Barrier to Accessible Cancer Care?

Patient Financial Assistance Programs: A Path to Affordability or a Barrier to Accessible Cancer Care?

The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients.

Limited transparency exists regarding eligibility and benefits for patient financial assistance programs (PAPs). To describe oral anticancer medication costs, insurance coverage, and the degree of financial assistance provided by PAPs. This was a retrospective study of prescription anticancer medication costs and PAP coverage. The study used data from an academic cancer center's specialty pharmacy. Medication, cost, and coverage data were collected from the specialty pharmacy database for prescriptions filled from January 2013 to November 2015. Prescriptions with missing copayments, insurance, or financial assistance amounts were excluded. Descriptive statistics summarized prescription characteristics. Of 9,388 anticancer medication prescriptions filled, 8,212 (87%) had complete cost data and were included. The 5 most common medications prescribed were capecitabine (20%), temozolomide (13%), enzalutamide (10%), letrozole (6%), and tamoxifen (4%). Most prescriptions were covered by commercial insurance or Part D (41.6%, n = 3,418). The median copayment was $20 per prescription (interquartile range [IQR] = $10.00-$80.30). When considering all prescriptions that received PAP assistance, the median amount of financial assistance provided by PAPs per prescription was $411.0 (IQR = $302.80-$523.40), amounting to 15% of the median prescription cash price. When considering all prescriptions, the median amount of financial assistance provided by PAPs per prescription was $0, and the mean was $79.30 (SD = $389.90). A minority of prescriptions received financial assistance from PAPs. The proportion of financial assistance was small relative to the price billed to insurance. PAPs play a modest role in reducing anticancer prescription-related costs. Support of this project by The Duke Biostatistics Core was made possible by Grant Number UL1TR001117 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Zullig is supported by a VA Health Services Research and Development (HSR&D) Career Development Award (CDA 13-025). Zullig also reports a financial relationship with Novartis. Zafar reports financial relationships with Novartis, Genentech-Roche, and Vivor. Vlastelica, Shankaran, and Wolf have nothing to disclose. The views in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, Duke University, NCATS, or NIH. This abstract was previously presented at the 2016 ASCO Annual Meeting; Chicago, Illinois; June 3-7, 2016. Study concept and design were contributed by Zafar, Zullig, and Vlastelica, with assistance from Shankaran. Vlastelica and Wolf took the lead in data collection, along with Zafar, and data interpretation was performed by Zullig, Zafar, and Wolf, along with Vlastelica and Shankaran. The manuscript was written and revised by Zullig and Zafar, along with the other authors.

Empowering patients to self-identify financial assistance programs using an online application.

4 Background: Available financial resources are relatively unknown to many patients with cancer facing high treatment-related costs. PAPNavigator is a web-based app designed to reduce out-of-pocket treatment costs by connecting patients to financial assistance programs specific to them. Traditionally used by financial counselors, PAPNavigator was modified to be patient-facing for this study, testing preliminary usability and effectiveness. Methods: Eligible patients with cancer were receiving anti-cancer treatment and reported out-of-pocket treatment costs. Patients interacted with PAPNavigator, inputted personal and financial data, and reviewed personalized financial resource results. Usability was assessed via the validated System Usability Scale (SUS). Effectiveness was assessed by two measures: “PAPNavigator improved my knowledge about financial aspects of cancer care and what can be done about it” and “Using this website was helpful with my financial concerns.” For all items, patients responded using a 5-point Likert scale. Results: 19 of 20 patients completed pilot testing (95%, 1 withdrew due to illness). 53% of patients were male, 26% were non-white, 79% had greater than a high school education, and 21% were employed full- or part-time. Median annual household income was $77,500. The median SUS score was 75 out of 100 (with >68 considered above average.) In response to statements, “I think that I would need assistance to be able to use this website,” and “I felt very confident using this website,” the median scores were 2 and 5 respectively. Additionally, in response to the statements, “PAPNavigator improved my knowledge about financial aspects of cancer care and what can be done about it,” and “Using this website was helpful with my financial concerns,” the median score for each was 4. Conclusions: The modified version of PAPNavigator demonstrated high usability and preliminary effectiveness in improving knowledge about financial aspects of cancer care and potential interventions to reduce cost. Further testing in larger samples is necessary.

Abstract P3-10-07: Impact of enrollment in clinical trials on survival of metastatic breast cancer patients

Abstract Background: The number of patients worldwide with metastatic breast cancer (MBC) who participate in therapeutic clinical trials has remained so far low. One of the reasons is a lack of opportunity, whereas another is fear of health care providers and patients of poor outcome of the use of new drugs. We therefore investigated whether survival in patients with MBC who participated in first-line therapeutic clinical trials is worse than that in patients who received only standard care and never enrolled in a clinical trial. We hypothesized that first-line therapeutic clinical trials do not negatively affect survival outcome. Methods: We reviewed the records of 5501 patients with MBC treated at The University of Texas MD Anderson Cancer Center from January 2000 to December 2010. We extracted a first cohort of 285 patients enrolled in a therapeutic clinical trial for the first time for first-line systemic MBC treatment. The second cohort, referred to as the eligible control population, consisted of 367 patients without comorbidities who did not participate in a clinical trial at any stage of their disease; these patients lived in Harris County, in which MD Anderson is located, and thus could be potentially eligible for MD Anderson's financial assistance program. To limit confounding factors, we excluded male patients and patients with known brain metastasis from both cohorts. Results: The median follow-up duration in our cohort was 7.16 years (95% confidence interval [CI], 6.53-7.64 years). We observed discrepancies in race (minorities were less represented in the clinical trial arm), estrogen receptor (ER) status (more ER-positive than ER-negative patients participated in clinical trials), and metastatic disease site (fewer patients with bone metastasis participated in clinical trials) between the two groups. Overall, we observed no significant differences in progression-free survival (PFS) or overall survival (OS) duration between the treatment arms. Specifically, in the clinical trial cohort, the median PFS duration was 7.00 months (95% CI, 5.72-8.71 months), and the median OS duration was 28.48 months (95% CI, 22.70-34.60 months). In the control cohort, the median PFS duration was 10.02 months (95% CI, 7.13-11.99 months), and the median OS duration was 28.71 months (95% CI, 24.41-31.31 months) (P = .089 and .335, respectively). Conclusion: In MBC patients, enrolling in first-line therapeutic clinical trials does not result in worse survival than does never enrolling in a clinical trial. This study should reassure health care providers in demonstrating that enrollment in a clinical trial does not negatively affect survival in MBC patients. Citation Format: Le Du F, FUJII T, Park M, Liu D, Hsu L, Gonzalez-Angulo A-M, Ueno NT. Impact of enrollment in clinical trials on survival of metastatic breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-07.

Transparency of Industry-Sponsored Oncology Patient Financial Assistance Programs Using a Patient-Centered Approach.

Pharmaceutical manufacturers sponsor drug-specific patient assistance programs that provide eligible patients with financial assistance, either in the form of providing the drug free of charge or copayment assistance. Describing these programs and determining who receives assistance is an important first step in understanding the impact and role of financial assistance in cancer care. Our objective was to describe eligibility criteria and benefits for cancer-specific, manufacturer-sponsored patient assistance programs. We conducted a prospective review of patient assistance program Web sites and called patient assistance program telephone hotlines from the perspective of a patient or caregiver requesting program details. We identified 24 manufacturers with patient assistance programs, covering 87% of Food and Drug Administration-approved oncology drugs. For free drug programs, the average maximum annual income for qualification was $86,279. For copayment assistance programs, the average was $104,790. Thirty-five percent of free drug programs and 53% of copayment assistance programs declined to provide details on how financial need was determined. None of the programs shared details on patient usage statistics. Variation exists in the quality and quantity of data available to patients seeking financial assistance for cancer treatment via manufacturer Web sites and hotlines. Greater transparency among patient assistance programs would enhance utility for patients and help to determine the net impact on costs and adherence.

“Cure” Effects and Mortgage Default: A Split Population Survival Time Model

Using non-agency securitization data consisting of mortgages originated between 1991 and 2007, we find that fraction of defaulted mortgages increases from 10.8% in the pre-crisis period (July 2007) to 19.6% in the post crisis period (July 2009). This paper then applies a split population hazard model, or widely known as a mixture cure model in biometrics literature, to jointly predict incidence (probability) and latency (hazard rate) of mortgage default, and more specifically to analyze the right-tail characteristics of the survival distributions of the sample mortgages. Our results show that negative equity is a highly significant factors driving both default incidence and latency for both adjustable rate mortgages (ARMs) and fixed rate mortgages (FRMs). We also show that borrowers’ credit score has weaker predictive effects on the latency (survival hazard) risks, but both low fico and subprime borrowers have higher probability to default in an adverse market condition, ceteris paribus. Borrowers with low credit scores have high default probabilities but with a longer time to default (hazard rate). They are more likely to hang onto their mortgages even they are “underwater” (negative equity). In term of the “cured” rate, we show that subprime borrowers with underwater (negative equity) FRM mortgages, and prime ARM borrowers have relatively higher “cured” rates in the mortgage sample. More policy experiments can be conducted using the mixture cure model to test the effectiveness of selected financial assistance programs in the future.

Austerity and labour market deregulation: High risks and weak justifications

16 | International Union Rights | 24/1 FOCUS | WORLD BANK AND IMF Austerity and labour market deregulation: High risks and weak justifications Financial crises can affect labour rights in a number of ways. Obviously, financial crises may reduce economic growth and employment and impair the right to work. However, in addition, governments have often undertaken reform measures that directly — such as reduction in wages and employment in the public sector aimed at reducing public expenditure or labour market deregulation in the private sector purportedly to increase competiveness — or indirectly — by creating economic conditions which increase pressure on workers, reducing wages or threatening employment, for example through privatisation of public enterprises, trade liberalisation or cutting domestic subsidies — affect labour rights. Labour-related austerity policies have been openly pushed by a number of official key creditors, including the World Bank and the International Monetary Fund (IMF), together, more recently, with the European Commission and the European Central Bank — the so-called Troika. Especially since the late 1980s, labour-related conditionality has featured prominently in IMF financial assistance programmes. Indeed, around 50 percent of all lending programmes have involved one or more labour-related conditions over the period from 1994 to 2007. Since then, the number of IMF programmes with labour conditionalities appears to have fallen, but still, between 25 to 40 percent of IMF programmes adopted until 2014 contained labour-related conditions relating to the public or the private sector1. International financial institutions have promoted labour law deregulation not only through formal conditionality to financial assistance arrangements. IMF has also made use of other instruments to advocate for deregulatory labour reforms, such as its Article IV consultations in the context of its bilateral macroeconomic surveillance2. These involve a certain amount of pressure and may also affect a country’s capacity to obtain financing elsewhere, given that potential or actual investors and bilateral lenders often have recourse to these reports3. Labour law issues in economic adjustment programmes While IMF has occasionally supported moderate improvements in labour standards4, its prevalent stance regarding labour law has been a deregulatory one. Close to one third of the available letters of intent addressed by governments to IMF between 1998 and 2005 contained commitments to be flexible with labour market regulation5. Early cases can be tracked to the 1950s, such as when IMF required Argentina to control wage increases. Adjustment measures implemented during the 1980s in the context of the Mexican debt crisis entailed a considerable reduction in both the number of public employees and their salaries, among others. The relevant reforms ranged from minor modifications to comprehensive reform packages with far-reaching amendments to both collective and individual labour laws. For example, during the 1990s, Côte d’Ivoire undertook reforms in the context of an IMF/World Bank-supported economic adjustment programme, which included the deregulation of the rules concerning temporary employment, dismissal and overtime, and involved the decentralisation of the collective bargaining system. Similarly, the structural adjustment programme carried out in Argentina during the 1990s entailed individual labour law reforms, involving, for instance, extending the duration of the probation period and collective labour law reforms, which granted firm-level agreements priority over sectoral agreements. In recent years, austerity-driven labour law reforms have remained a widespread trend. No fewer than 89 countries implemented such reforms Austerity-driven labour law reforms have remained a widespread trend. As a result, the level of protection of labour law has been substantially reduced Juan Pablo Bohoslavsky is the United Nations Human Rights Council-appointed Independent Expert on foreign debt and human rights Austerity-related labour law reforms between 2010 and 20157 9 18 40 34 East Asia and Pacific Highincome countries Number of austerity-related labour law reforms Number of cuts in or caps on public sector wages 3 7 6 8 South Asia Middle East/ North Africa 11 14 12 17 Latin America/ Caribbean Eastern Europe/ Central Asia 8 32 SubSaharan Africa FOCUS | WORLD BANK AND IMF 17 24/1 | International Union Rights | between 2010 and 2015 and more than half (49) of them were implemented in developing countries. In addition, 130 countries had reportedly implemented or were contemplating cuts in or caps on publicsector salaries, more than two...

When Do Countries Implement Structural Reforms?

The objective of this paper is to investigate which factors macroeconomic, policy‐related or institutional ‐ foster the implementation of structural reforms. To this objective, we look at episodes of structural reforms over three decades across 40 OECD and EU countries and link them to such factors. Our results suggest that structural reforms implementation is more likely during deep recessions and when unemployment rates are high. Moreover, the further distant from best practices, the more likely a country implements reforms. External pressures, such as being subject to a financial assistance programme, or being part of the EU Single Market facilitated pro‐competitive reforms. If at all, low interest rates tend to promote rather than discourage structural reforms, while there seems no clear link between fiscal policy and reforms. Moreover, reforms in product markets tend to increase the likelihood of labour market reforms following suit. Many robustness checks have been carried out which confirm our main results. JEL Classification: C23, D70, D72, P11, P16

Social Solidarity Allowance and Tax-Free Threshold in Greece: 2010-2016

This policy paper concerns the changes in the legislation of the Social Solidarity Allowance and the tax-free threshold in Greece, after the request for financial assistance from the European Union and the International Monetary Fund in 2010. After a concise analysis of the above from 2010 to 2016, the history and effects of the changes introduced for each of the two above issues, and their combination, by the Memorandums of Understanding for the Financial Assistance Programs, such as the proposal for the funding of the Solidarity Allowance from 2016 onwards with revenue from the reduction of the tax-free amount.

Communication practices and awareness of resources for acromegaly patients among endocrinologists.

PurposeThis study was designed to assess the awareness and utilization of resources to improve patients’ treatment experiences among endocrinologists who currently treat patients with acromegaly.MethodsA total of 4,280 US endocrinologists were randomly selected from the CMS National Plan and Provider Enumeration System and were invited by mail to participate in a 20-minute online survey. In order to qualify, respondents had to be the primary physician making treatment decisions for at least one patient for their acromegaly.ResultsResults are based on responses from 126 physicians from primarily urban and suburban practices, with a median of five acromegaly patients. A total of 70% of patients are currently receiving drug therapy; among these, 91% are on octreotide (51%), lanreotide (29%), or pasireotide (11%), alone or in combination with another therapy. Nearly half of the respondents thought that the impact of patient adherence on therapy outcome for acromegaly was either not very (40%) or not at all (7%) significant. Respondents who believe patient adherence significantly impacts treatment outcome were significantly more likely to discuss automated adherence reminders (50% vs 26%; P=0.015), mobile administration programs (57% vs 35%; P=0.029), and symptom tracking (72% vs 42%; P=0.002). Overall, 44% of respondents routinely recommend education/emotional support programs, and 25% routinely recommend financial assistance programs. Respondents who believe patient adherence significantly impacts treatment outcome generally were more familiar with individual education and emotional support programs compared to those who do not, although they were not more likely to routinely refer patients to any of these resources.ConclusionThere are unmet needs with respect to increasing awareness among physicians of the importance of patient adherence to therapy, resources available to patients, and how collaboration among patients, nurses, and physicians can improve adherence and overall treatment experiences.

Analyzing Mortgage Default Behavior with Split Population Survival Time Models

Using non-agency securitization data consisting of mortgages originated between 1991 and 2007, we find that fraction of defaulted mortgages increases from 10.8% in the pre-crisis period (July 2007) to 19.6% in the post crisis period (July 2009). This paper then applies a split population hazard model, or widely known as a mixture cure model in biometrics literature, to jointly predict incidence (probability) and latency (hazard rate) of mortgage default, and more specifically to analyze the right-tail characteristics of the survival distributions of the sample mortgages. Our results show that negative equity is a highly significant factors driving both default incidence and latency for both adjustable rate mortgages (ARMs) and fixed rate mortgages (FRMs). We also show that borrowers’ credit score has weaker predictive effects on the latency (survival hazard) risks, but both low fico and subprime borrowers have higher probability to default in an adverse market condition, ceteris paribus. Borrowers with low credit scores have high default probabilities but with a longer time to default (hazard rate). They are more likely to hang onto their mortgages even they are “underwater” (negative equity). In term of the “cured” rate, we show that subprime borrowers with underwater (negative equity) FRM mortgages, and prime ARM borrowers have relatively higher “cured” rates in the mortgage sample. More policy experiments can be conducted using the mixture cure model to test the effectiveness of selected financial assistance programs in the future.

Factors influencing the adoption of riparian forest buffers in the Tuttle Creek Reservoir watershed of Kansas, USA

Environmental benefits of riparian forest buffers (trees located along streams) are well documented, yet an understanding of factors influencing landowner adoption on properties adjacent to agricultural fields is limited. Reasons for adoption and non-adoption were examined using survey data collected from landowners in Kansas’ Tuttle Creek Reservoir watershed, an area of high concern for water quality and quantity. Survey questionnaires focused on four latent adoption factors: attitudes toward trees, economic motivation, knowledge of riparian forest buffer benefits, and perceptions of government-funded incentive programs. Responses were analyzed with Spearman’s correlation coefficient to determine whether relationships existed between landowner type and each latent adoption factor, Cronbach’s alpha for scale reliability, and the Mann–Whitney U test for differences between adopters and non-adopters. Significant differences between landowner types were revealed indicating that riparian forest buffers were not likely to be adopted if landowners had unfavorable attitudes toward trees, were motivated by economic factors, were unaware of riparian forest buffer benefits, or had negative perceptions of the current design of government payment programs for establishing trees in riparian areas. The following themes were identified for their potential to increase adoption: riparian forest buffers need to be perceived as profitable; opportunities exist for education; financial and technical resources represent major constraints to riparian forest buffer adoption; and there is an apparent need to create awareness of financial assistance programs.

Improving, Restoring, and Managing Natural Resources on Rural Properties in Florida: Sources of Financial Assistance

Interested in conserving natural resources, such as wildlife habitat, or protecting the agricultural heritage of your land? Both federal and state governments have technical and financial assistance programs to help rural landowners achieve natural resource goals. These challenges are addressed through land rentals, technical assistance, cost-shares, and incentive payments and include both time-limited and permanent land-use options. This revised 8-page fact sheet informs landowners about government programs available to help conserve natural resources. Written by Chris Demers, Martin B. Main, and Mark E. Hostetler, and published by the UF School of Forest Resources and Conservation, November 2016. SS-FOR-23/FR156: Improving, Restoring, and Managing Natural Resources on Rural Properties in Florida: Sources of Financial Assistance (ufl.edu)

Monetary Union Dynamics with Unsustainable Public Debt

There have been many attempts at solving the problem of determining the “fundamental value” of the credit spread of a government bond. This is particularly important in the case of Eurozone, where the ECB intervention on the government bonds’ market is allowed only if the “spread” paid by the sovereign issuer is higher than the one justified by “fundamentals”. The complication in determining what is a fair level of the spread stems from the fact that public debt sustainability depends on many factors, among them the level of interest rates paid. This sort of circularity between debt sustainability and interest rate paid by the sovereign issuer is the major source of complexity. This paper highlights a possible solution inside a simplified framework resembling the peculiar institutional settings of the Eurozone: no possibility of money-financing, the famous Maastricht Treaty 3%-60% parameters, availability of financial assistance program subordinated to the acceptance of consolidation plans for public finances. We obtain the possibility of multiple equilibria for the credit spread, whose stability can be analyzed through a phase diagram. The dynamics of the model is derived from probabilistic assumptions about the public debt process. It does not depend on “loss” functions devised to model the strategic relationship between debtors and creditors, as in previous literature on public debt sustainability. Dynamic properties of equilibria can be used to gain insight on what does it mean “good” or “bad” equilibrium from the perspective of the ECB.

How Do Pharmacists Assist Medicare Beneficiaries with Limited Income? A Cross-Sectional Study of Community Pharmacies in Alabama.

Many Medicare beneficiaries have limited income and report problems paying for their medications. Programs are available to assist these low-income individuals. However, these programs are underused because of lack of general awareness and perceived complexity of program applications. To (a) determine the frequency of encounters by pharmacists with Medicare beneficiaries who cannot afford prescription drugs; (b) identify strategies that pharmacists use to assist Medicare beneficiaries who cannot afford prescription drugs; and (c) explore what pharmacists know about programs for Medicare beneficiaries with limited income. This study used a mixed-mode survey of 350 randomly sampled community pharmacies located in 32 counties in Alabama with a high proportion of Medicare beneficiaries who were potentially eligible for low-income subsidy programs. Measures included frequency of encounters by pharmacists with Medicare beneficiaries who could not afford their medications, strategies used to assist Medicare beneficiaries, and pharmacists' knowledge of programs for Medicare beneficiaries with limited income. Of 350 surveys sent, 12 were nondeliverable, and 151 were completed (response rate=44.6%). About 50% of respondents reported encountering Medicare beneficiaries who could not afford their medications at least weekly. Various strategies were reported, including refiling claims that were previously denied every day (40.7%), contacting insurance companies at least once per week (43.2%), and loaning medications at least 2-3 times per month (29.1%). Only 12.6% reported referring beneficiaries to the Aging and Disability Resource Centers (ADRCs) to assess eligibility for limited-income programs. When asked about programs for beneficiaries with limited income, the answers were predominantly "don't know for sure." Several strategies were used by pharmacists in an attempt to help limited-income Medicare beneficiaries obtain their medications. Lack of knowledge about financial assistance programs for limited-income individuals and the role of ADRCs in helping to screen individuals for benefits and complete applications warrants immediate attention. Improving pharmacists' knowledge on this topic may be an effective mechanism for providing a long-term solution for their patients. This study was funded by the Alabama Department of Senior Services. The sponsor played no active role in the design, methods, data collection, analysis, or preparation of this manuscript. The authors have nothing to disclose. This paper was presented at the American Pharmacists Association meeting in Baltimore, Maryland, in 2016. Study concept and design were contributed by Westrick. Hastings and McFarland were responsible for data collection, along with Westrick. Data interpretation was performed by Westrick, L. Hohmann, and Hastings, with assistance from McFarland. All authors were involved with manuscript preparation.

The impact of homelessness prevention programs on homelessness.

Despite the prevalence of temporary financial assistance programs for those facing imminent homelessness, there is little evidence of their impact. Using data from Chicago from 2010 to 2012 (n = 4448), we demonstrate that the volatile nature of funding availability leads to good-as-random variation in the allocation of resources to individuals seeking assistance. To estimate impacts, we compare families that call when funds are available with those who call when they are not. We find that those calling when funding is available are 76% less likely to enter a homeless shelter. The per-person cost of averting homelessness through financial assistance is estimated as $10,300 and would be much less with better targeting of benefits to lower-income callers. The estimated benefits, not including many health benefits, exceed $20,000.

Military Neurosurgery: A Range of Service Options.

The pathway to military neurosurgical practice can include a number of accession options. This article is an objective comparison of fiscal, tangible, and intangible benefits provided through different military neurosurgery career paths. Neurosurgeons may train through active duty, reserve, or civilian pathways. These modalities were evaluated on the basis of economic data during residency and the initial 3 years afterwards. When available, military base pay, basic allowance for housing and subsistence, variable special pay, board certified pay, incentive pay, multiyear special pay, reserve drill pay, civilian salary, income tax, and other tax incentives were analyzed using publically available data. Civilians had lower residency pay, higher starting salaries, increased taxes, malpractice insurance cost, and increased overhead. Active duty service saw higher residency pay, lower starting salary, tax incentives, increased benefits, and almost no associated overhead including malpractice coverage. Reserve service saw a combination of civilian benefits with supplementation of reserve drill pay in return for weekend drill and the possibility of deployment and activation. Being a neurosurgeon in the military is extremely rewarding. From a financial perspective, ignoring intangibles, this article shows most entry pathways with initially modest differences between the cumulative salaries of active duty and civilian career paths and with higher overall compensation available from the reserve service option. These pathways become increasingly discrepant over time as civilian pay greatly exceeds that of military neurosurgeons. We hope that those curious about or considering serving in the United States military benefit from our accounting and review of these comparative paths. FAP, Financial Assistance ProgramNADDS, Navy Active Duty Delay for SpecialistsTMS, Training in Medical Specialties.